ORAL PRESENTATION Open Access

Severity prediction for Clostridium difficileinfection with ATLAS score – new data from aless developed country (Romania)Irina Crîşmaru1, Șerban Benea1,2, Gabriel Adrian Popescu1,2*

From The 9th Edition of the Scientific Days of the National Institute for Infectious Diseases Prof Dr Matei BalsBucharest, Romania. 23-25 October 2013

BackgroundThe emergence of ribotype 027 increased the severity ofClostridium difficile infection (CDI). Fast severity assessingplays an essential role in decreasing the mortality due toCDI; early surgery is the best intervention to decrease thelethality in severe CDI with toxic megacolon. Severalseverity scores were defined, including the ATLAS score,but the validation studies were performed in developedcountries with structured medical practice. We evaluatedthe usefulness of ATLAS score and of its components asindicators for CDI severity (deaths, length-of-stay, costs).

MethodsWe calculated in a retrospective manner the ATLAS scorefor 170 consecutive patients with CDI, admitted in theNational Institute for Infectious Diseases “Prof. Dr. MateiBalş” during a seven months period, September 2012 toMarch 2013. The mean and median values for parametersof ATLAS score as the score itself were compared for sur-vivor (S; n=159 patients) and non-survivor (NS; n=11)groups.

ResultsThe median value of ATLAS score was significantly higherin the non-survivors as in survivors: 6 versus 3, p=0.00002.The highest relative risk of death was associated with avalue of ATLAS score of 5 or more, RR = 16.46 (95% CI:3.69-73.46; p=0.0002). The patients in NS group wereolder: 79 years versus 64.1 years (p=0.000076), had agreater value of highest temperature: 38.7°C versus 37.9°C(p=0.00028), and a lower level of initial albuminemia:2.33 g/dL versus 3.12 g/dL (p=0.00044). For the initial

WBC count the value is greater in NS group, with almostdefined statistical significance: 21,918/cmm versus 12,130/cmm (p=0.071). Concomitant systemic antibiotic treat-ment was prescribed in 5 of 11 patients in NS group andin 48 of 159 patients in S group, p=0.29; the overall conco-mitant systemic antibiotic use was 32.1%, greater than inthe validation study of ATLAS score (19%). The meanduration of hospitalization in all patients was 12.5 days;the value of ATLAS score was also positively correlated tothe length-of-stay, R2=0.922. The mean cost of medicationwas 2697.4±4685.55 RON (range 25-31254 RON); thevalue of ATLAS score had a good correlation with medi-cation costs: R²=0.732, p=0.003.

ConclusionThe ATLAS score confirmed its value as predictor ofoutcome in CDI patients, for lethality, lenght-of-stayand direct costs of medication. Among ATLAS scoreparameters, only simultaneous CDI treatment and sys-temic antibiotics use was not significantly different in Sand NS groups, due to the large extent of systemic anti-biotic treatment in our patients.

Authors’ details1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.2National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest,Romania.

Published: 16 December 2013

doi:10.1186/1471-2334-13-S1-O21Cite this article as: Crîşmaru et al.: Severity prediction for Clostridiumdifficile infection with ATLAS score – new data from a less developedcountry (Romania). BMC Infectious Diseases 2013 13(Suppl 1):O21.

* Correspondence: gabrielp9@yahoo.com1Carol Davila University of Medicine and Pharmacy, Bucharest, RomaniaFull list of author information is available at the end of the article

Crîşmaru et al. BMC Infectious Diseases 2013, 13(Suppl 1):O21http://www.biomedcentral.com/1471-2334/13/S1/O21

© 2013 Crîşmaru et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.